The aim of this study was to evaluate the usefulness of the free osteofasciocutaneous fibular flap in mandible reconstruction in 23 patients. We reviewed their clinical records and asked the subjects to answer a questionnaire, as well as to attend our hospital for a clinical and radiological examination. The mean follow up was 1.3 years. In 15 patients, the flap was used for contemporaneous intraoral mucosal and extraoral cutaneous reconstruction. In seven cases, bilateral mandibular reconstruction was performed. Skin paddle edge necrosis was observed in seven flaps postoperatively, however, no total flap loss resulted. No additional soft-tissue flap was needed since the fibular flap harvested held an extended skin paddle reaching up to 352 cm(2). The donor-site morbidity was moderate and furthermore most of the patients were satisfied with their functional and aesthetic result. The free osteofasciocutaneous fibular flap is the best possible therapy for the demanding reconstruction of the mandible. The fibular bony part is a safe foundation for the placement of osseointegrated implants which further improves the patient's quality of life.